People v. Protopappas

Rule of Law:

Implied malice, necessary for second-degree murder, can be established when a medical professional performs intentional acts, the natural consequences of which are dangerous to life, and does so with subjective awareness that their conduct endangers the life of another, acting with conscious disregard for life.

Facts:

• In 1982-1983, Dr. Tony Protopappas, a licensed dentist and oral surgeon, owned a dental clinic where he was the only dentist licensed to administer general anesthesia and standardized initial drug doses for patients.
• On September 21, 1982, Kim Andreassen, a frail 24-year-old with multiple severe health conditions (lupus, kidney failure, high blood pressure, anemia, heart murmur, seizure disorder), informed Protopappas of her conditions and medications; her general physician later advised against general anesthesia even for a short time.
• On September 30, 1982, Protopappas administered his standard 'massive' doses of intravenous drugs and a local anesthetic to Andreassen, who soon exhibited irregular breathing, a pale blue face, and an irregular pulse, but Protopappas dismissed these symptoms and delayed calling paramedics until after she had stopped breathing.
• On February 8, 1983, Protopappas administered his standard intravenous medications to 13-year-old Patricia Craven, who had swollen tonsils, then delegated her care and repeated administration of anesthetics to Dr. Marietta Badea, an unlicensed dentist, with instructions to give more drugs whenever Craven became 'light,' without Protopappas personally monitoring her.
• Craven was discharged unresponsive, unconscious, limp, and breathing irregularly, with Protopappas documenting her labored breathing due to swollen tonsils and throat gauze, and she died 11 days later after developing pneumonia.
• On February 11, 1983, while Craven was in a coma, Cathryn Jones, 31, who had a history of a pituitary tumor and severe dental problems, received Protopappas's standard drug setup despite her physician's approval for only sodium pentothal and his warning that his standard drugs could cause respiratory depression.
• During Jones's procedure, Protopappas was told three times by an assistant that Jones's lips and fingernails were turning purple, but he dismissed these warnings angrily, delayed giving oxygen, and interrupted CPR efforts, leading to her death two days later.

Procedural Posture:

• A jury found Tony Protopappas guilty of the second-degree murder of three patients.
• Protopappas appealed the judgment to the Court of Appeal.
• The Court of Appeal previously filed an opinion affirming the judgment.
• The California Supreme Court granted review and retransferred the matter to the Court of Appeal with directions to delete references to a depublished opinion and to refile upon finality of another case (which was also later depublished).